Childbearing Normal

Question 1

Estimated date of birth (confinement) - Nagel’s rule

Answer 1

last day of menstrual period - 3 months + 7 days + 1 year

Question 2

Ultrasonography

Answer 2

estimates fetal age from head measurements

Question 3

fundal height measurement

Answer 3

from top of symphysis pubis to the top of the fundus

• above level of symphysis - 12-14 weeks
• at umbilicus (20 cm) - about 20 weeks
• rises about 1cm/week until 36 weeks

Question 4

Gravada

Answer 4

total number of pregnancies

Question 5

Para

Answer 5

number of past pregnancies beyond period of viability (20 weeks, >500 g)

Question 6

Term

Answer 6

38-42 weeks

Question 7

Chadwick’s sign

Answer 7

bluish color of cervix (probable sign of pregnancy)

Question 8

Hegar’s sign

Answer 8

softening and compressibility of isthmus uterus (probable sign of pregnancy)

Question 9

Fetal assessment (FHR and movement): Normal

Answer 9

FHR 120-160 at term
Fetal movement - regular pattern of 10 movements in 20 minutes to 2 hrs twice a day
fewer than three movements in a 1 hr period should be reported

Question 10

Non-stress test

Answer 10

After 28 weeks records fetal movements and FHR
pt should eat snacks
favorable results is 2 or more FHT accels of 15 bpm lasting 15 seconds over a 20 minute interval

Question 11

Contraction stress test

Answer 11

performed at 28 weeks
semi fowlers or side lying
Positive - late decels with at least 50% of contractions - potential risk to fetus; cesarean may be necessary
-Negative - no late decels with minimum of 3 contractions lasting 40-60 seconds in 10 minute period

Question 12

TORCH infections: health risks to fetus

Answer 12

Toxoplasmosis
Other: syphilis, Group B strep, Hep B; A, AIDS
Rubella
Cytomegalovirus (from Herpes virus)
Herpes Simplex

Question 13

Danger signs of pregnancy

Answer 13

Gush of fluid or bleeding from vagina
Regular uterine contractions
Severe headaches, visual disturbances, abdominal pain, persistent vomiting
Fever or chills
Swelling in face and fingers
...see physician if these occur

Question 14

Lightening

Answer 14

descend into pelvis (baby “drops”) - two weeks before delivery

Question 15

Cervical changes during labor

Answer 15

Effacement - progressive thinning and shortening of cervix (0 - 100%)
Dilation (0-10cm)
Rupture of membranes - check FHR

Question 16

S/Sx of prolapsed cord

Answer 16

symptoms: premature ROM, presenting part not engaged, fetal distress, protruding cord
Nursing care: call for help, push against presenting part to relieve pressure on cord, place in Trendelenburg or knee-chest position
Successful treatment - fetal heart tones remain unchanged

Question 17

Fetal monitoring: FHR

Answer 17

Normal FHR 120-160

Tachycardia 160 bpm more than 10 minutes -

Question 18

Fetal tachycardia

Answer 18

FHR > 160 longer than 10 minutes
early sign of fetal hypoxia
associated with maternal fever, fetal anemia, fetal or maternal infection, drugs, maternal hyperthyroidism, fetal heart failure, nonreassuring sign when associated with late decels, severe variable decels, or absence of variability

Question 19

Fetal bradycardia

Answer 19

FHR <110-120 longer than 10 minutes
late sign of fetal hypoxia
associated with maternal drugs (anesthetics), prolonged cord compression, fetal congenital heart block, maternal supine hypotensive syndrome, nonreassuring sign when associated with loss of variability and late decelerations

Question 20

Fetal decelerations (early, late, variable)

Answer 20

Early: head compression - benign
Late: fetal hypoxia - deficient placental perfusion
caused by PIH, maternal diabetes, placenta previa, abruption placentae, nonreasurring sign
Variable: more than 15 bpm lasting 15 seconds -return to baseline less than 2 minutes after contraction
ominous if repetitive, prolonged, severe, or slow return to baseline
-administer O2, discontinue oxytocin, move to left side, prep for c-section

Question 21

Lie

Answer 21

relationship of spine of fetus to spine of mother
Longitudinal - parallel
Transverse - right angles
Oblique - angled

Question 22

Presentation

Answer 22

Part of fetus that presents to maternal pelvic inlet
Cephalic/vertex - head
Breech - buttocks
-Frank - hips flexed/knees extended
-complete - legs crossed
-footing - one of feet down (may be first part out)
Shoulder

Question 23

Position

Answer 23

Relationship of fetal reference point to maternal pelvis.
Fetal reference point
-Occiput (o)
-Sacrum (s)
Maternal pelvis is designated right/left (R/L), anterior/posterior (A/P)
LOA most common

Question 24

Station

Answer 24

Level of presenting part in relation to imaginary line between ischial spines (zero station)

Question 25

Phases of contractions

Answer 25

Increment - from beginning of contraction until peak
Acme/peak -strongest intensity
Decrement - diminishing intensity

Question 26

Characteristics of contractions

Answer 26

Frequency - beginning of one to beginning of next
Duration - time in seconds from beginning to end
Intensity - strength (mild to strong) subjective or palpation.

frequency of less than 2 minutes should be reported - close to delivery
Duration greater than 90 seconds reported - stressful for infant (uteran rupture or fetal distress)

Question 27

4 Stages of labor

Answer 27

1. Beginning of labor to complete cervical dilation (0-10cm)
2. Complete dilation to birth
3. Birth to delivery of placenta
4. first 4 hours after delivery of placenta

Question 28

First stage of labor: 3 phases

Answer 28

phase 1 - latent
0-3 cm
contractions 10-30 sec long, 5-30 min apart
mild to moderate intensity
Phase 2 - active
4-7 cm
contractions 30-40 sec long, 3-5 min part
mod to strong 
Phase 3 - transition
8-10 cm
contractions 45-90 sec long, 1.5-2 min apart
strong

Question 29

Second stage of labor: 3 phases

Answer 29

phase 1 
0 to +2 station
contractions 2-3 min apart
phase 2
\+2 to +4 station
contractions 2-2.5 min apart
increase dark read bloody show
increased urgency to bear down
phase 3
\+4 to birth
contractions 1-2 min apart; fetal head visible; increased urgency to bear down

Question 30

Fetal distress: irregular HR

Answer 30

turn mother to left side
give supplemental O2
check for cord prolapse
start IV

Question 31

Fetal distress: umbilical cord prolapse

Answer 31

elevate presenting part off cord
call for help
place mother in trendelenburg or knee-bent position
O2, IV

Question 32

Lochia appearance after delivery

Answer 32

Drainage from vagina
Day 1-3: Rubra - bloody
Day 4-9: Serosa - pink-brown
Day 10+: Alba - yellow-white
Foul odor indicates infection at any time

Question 33

When is RhoGAM indicated?

Answer 33

Rh positive fetus and Rh negative mother

Give before mother develops antibodies against fetal blood